Tinea capitis in adults: not so rare

Abstract

Shahab-ud-din Bukhari 1 INTRODUCTION Tinea capitis is the dermatophyte infection of the scalp with varied clinical presentation. Tinea capitis is predominantly seen in preadolescent adults and is rare in adults. In adults cases generally occur in immunocompromised patients. Tinea capitis may be rare in adults due to the fungistatic activity of long chain saturated fatty acids in sebum which appear after puberty and unknown immunological factors. 1 Colonization by Malassezia globosa may interfere with dermatophyte contamination, and the thicker calibre of adult hair may protect against dermatophytic invasion. 2 Tinea capitis presents clinically as irregularly shaped scaly alopecic patches, with hair broken off at varying levels from hair follicle. 3-5 The clinical presentation in adults is often atypical; resembling impetigo, folliculitis decalvans or scalp cellulitis. 6,7 This atypical presentation along with rarity of the condition in adults often leads to delay in diagnosis. METHODS This is a prospective study conducted in Department of Dermatology of SKIMS-MCH from April 2015 to March 2016. The study included all patients older than 18 years. Ethical Clearance was taken from Institute Ethics Committee. Informed consent was obtained from all patients. Clinically suspected cases of tinea capitis were confirmed by mycological examination. Clinical material was microscopically examined with the use of 20% KOH for hyphae and arthroconidia. The Samples ABSTRACT Background: Tinea capitis is the dermatophyte infection of the scalp with varied clinical presentation. Tinea capitis is predominantly seen in preadolescent adults and is rare in adults. Growing number of authors have reported increase in incidence among adults. Clinical presentation in such case is often atypical leading to delay in diagnosis. Methods: The study included all patients older than 18 years. Informed consent was obtained from all patients. Clinical material was microscopically examined with the use of 20% KOH for hyphae and arthroconidia. The Samples were also inoculated on Sabourauds Agar and Mycosel Agar for 15 days. For each patient we collected information about sex, menstrual status, predisposing factor, symptoms and etiological agent. Results: Out of 457 cases of tinea capitis 14 patients were adults and represented 3.06% of all cases. All patients were females. The most common etiological agent was T. violaceum (35%), followed by T. mentagrophytes (21.43%), T. tonsurans (14.29%), T. rubrum (14.29%) and T. schoenleinii (14.29%). Conclusions: Tinea capitis in adults is not so rare, particularly in post-menopausal women. The presentation is often atypical mimicking other inflammatory conditions of scalp and should be included as a differential diagnosis of inflammatory conditions not responding to conventional treatment.

Aetiological changes of tinea capitis in the Hubei area in 60 years: Focus on adult tinea capitis

“…In contrast, Romano et al 14 suggested that increased contact with animals, immune system defects in patients and the strong capacity of M. canis to adapt to environmental changes might contribute to the predominance of M. canis in Italy. T. violaceum , another common causative agent of adult tinea capitis, is the most prevalent aetiology in countries in Asia (China, 23–25 India 45 ), Africa (South Africa, 46 Senegal 47 ) and the Middle East (Egypt, 19 Tunisia, 20 Morocco, 21 Pakistan, 22 Iran 1 ). Some European counties including Spain 4 and Greece 8 are also endemic areas of T. violaceum .…”

“…T. violaceum, another common causative agent of adult tinea capitis, is the most prevalent aetiology in countries in Asia (China, [23][24][25] India 45 ), Africa (South Africa, 46 Senegal 47 ) and the Middle East (Egypt, 19 Tunisia, 20 Morocco, 21 Pakistan, 22 Iran 1 ). Some European counties including Spain 4 and Greece 8 are also endemic areas of T. violaceum.…”